Trans-Vertical Mastectomy With Immediate Implant-Based Reconstruction: A Retrospective, Observational Study

Scheflan, Michael; Lotan, Adi Maisel; Allweis, Tanir

doi:10.1093/asj/sjy181

Cited by 7 publications

(7 citation statements)

References 30 publications

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“…The preferred incisions used were inframammary for nipple-sparing mastectomy, radial oblique in the upper outer quadrant for skin-sparing mastectomy, and trans-vertical ellipses for skin-reducing mastectomy. 9 …”

Section: Methodsmentioning

confidence: 99%

Meshed Acellular Dermal Matrix in Immediate Prepectoral Implant-based Breast Reconstruction

Scheflan

Allweis

Yehuda

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Prepectoral implant placement has many potential advantages in immediate breast reconstruction. Acellular dermal matrices (ADMs) are commonly used in these surgeries. ADM meshing may enhance integration, decrease seroma and infection rates, and reduce surgical costs. Methods: This was a retrospective, single-center study of 49 women (71 breasts) undergoing immediate, prepectoral, implant-based breast reconstruction with 2:1 meshed, bovine-derived ADM (SurgiMend). Outcomes were compared against those of 77 patients (105 breasts) undergoing a similar procedure but with partial subpectoral implant placement. Results: In the prepectoral group, the mean age was 49.1 years and mean body mass index was 24.7 kg/m 2 . There were no significant differences in baseline characteristics versus the partial subpectoral control group. Mean follow-up was 18.6 months (prepectoral) and 21.3 months (partial subpectoral). Mean time to drain removal was reduced in the prepectoral group (6.5 versus 8.5 days; P < 0.001). Rates of minor and major complications with prepectoral implant placement were 15.5% and 11.3%, respectively – similar to partial subpectoral placement (15.2% and 14.3%) (overall P = 0.690). Capsular contracture and explantation were associated with radiation therapy, and rates were similar between groups. Conclusions: Prepectoral implant placement with meshed ADM is a safe and reproducible alternative to partial muscle coverage with meshed ADM. Recovery may be easier and animation deformity avoided. It could therefore become the standard of care for implant-based breast reconstruction.

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Section: Methodsmentioning

confidence: 99%

Meshed Acellular Dermal Matrix in Immediate Prepectoral Implant-based Breast Reconstruction

Scheflan

Allweis

Yehuda

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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“…We found errors in BREAST-Q administration or insufficient reporting of administration methods in more than half of the studies analyzed (n = 99 [53.5 percent]). Of studies with errors in BREAST-Q administration (n = 36), the most common reasons for improper administration included the addition, deletion, or alteration of scale items (n = 8 [22.2 percent]), [18][19][20][21][22][23][24][25] presenting raw scores rather than the converted Q score (n = 14 [38.9 percent]), [26][27][28][29][30][31][32][33][34][35][36][37][38][39] averaging individual scales into one score (n = 6 [16.7 percent]), 20,34,[40][41][42][43] and patients not completing the BREAST-Q themselves directly (i.e., completed through a telephone interview or with help from a caregiver or interpreter) (n = 7 [19.4 percent]). [44][45][46][47][48][49][50] Most studies (n = 114 [61.6 percent]) did not provide a time horizon for their primary outcome.…”

Section: Resultsmentioning

confidence: 99%

Best Practices for BREAST-Q Research: A Systematic Review of Study Methodology

Gallo

Chu

Shamsunder

et al. 2022

Plastic &Amp; Reconstructive Surgery

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he BREAST-Q Reconstruction Module is a validated, reliable, and responsive patientreported outcome measure. 1,2 Developed in 2009, it has become the standard patientreported outcome measure for evaluating patient satisfaction and health-related quality of life in patients undergoing breast reconstruction. The BREAST-Q has been recommended by the International Consortium for Health Outcomes Measurement to be a standard of care patientreported outcome measure for patients with breast cancer 3 and the U.S. Food and Drug Administration has approved the BREAST-Q as a

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“…The elliptical excision resulting in a transverse scar has been criticized for poor aesthetic outcome involving flattening of the breast apex, and residual medial and lateral dogears, particularly in larger breasted patients. 12 , 23 Subjectively, the bell pattern creates a more rounded breast shape. This is thought to be due to the curvature allowing for continuously changing tension vectors rather than a single tension vector, akin to Z-plasty.…”

Section: Discussionmentioning

confidence: 99%

“…In patients undergoing SRM, elliptical excision has been criticized for poor aesthetic outcomes, such as flattening projection, and leaving prominent medial and lateral “dogears” 8 made worse in very large or ptotic breasts. To address these shortcomings, surgeons have reported numerous alternative excision patterns, including oblique, 9 circumvertical, 10 , 11 trans-vertical, 12 Lazy S, 13 double-mirrored omega, 14 and inframammary skin sparing patterns. 15 Yet others instead discourage a single-stage approach and recommend performing staged procedures only (ie, oncoplastic reduction prior to mastectomy).…”

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confidence: 99%

The Bell Pattern: A Novel Breast Incision Approach to Skin-Reducing Mastectomies

Albright¹,

Hawkes²

2019

Aesthetic Surgery Journal Open Forum

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Background As immediate direct to permanent implant-based breast reconstruction (IBBR) continues to gain in popularity, surgeons seek to apply these techniques to patients with large or ptotic breasts. A new bell pattern skin excision is described and limits major complications in this high-risk population. Objective The authors describe a novel skin excision pattern for patients with large or ptotic breasts who desire IBBR and assess its safety. The authors also evaluated the ability of the pattern to account for intraoperative developments. Methods This retrospective analysis of a single surgeon’s experience included 17 consecutive patients (31 breasts) with large or ptotic breasts undergoing skin-reducing mastectomy with attempted utilization of the bell pattern approach and IBBR with acellular dermal matrix. Results Mean age was 50 years, mean body mass index was 27.4 kg/m2, and mean breast specimen weight was 683g. A bell pattern excision was planned for all breasts preoperatively. Three breasts (10%) required an alternative closure pattern due to intraoperative ischemia (n=1), or additional oncologic resection (n=2). The pattern successfully accommodated flap ischemia in 8 (26%) other breasts. After a median follow up of 5.1 months, the number of bell pattern breasts with major and minor complications was 0 (0%) and 9 (32%), respectively. The most common minor complication was seroma (n=5, 18%), and minor incision wound (n=3, 11%). There were no reconstruction failures utilizing the bell pattern. Conclusion The bell pattern approach is a safe and adaptable alternative to traditional skin-reducing mastectomy in patients with large or ptotic breasts.

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Trans-Vertical Mastectomy With Immediate Implant-Based Reconstruction: A Retrospective, Observational Study

Abstract: The trans-vertical approach is an effective, reproducible and safe alternative to conventional skin-reducing mastectomy, with favorable aesthetic outcomes, in patients with large and ptotic breasts.

Cited by 7 publications

References 30 publications

Meshed Acellular Dermal Matrix in Immediate Prepectoral Implant-based Breast Reconstruction

Meshed Acellular Dermal Matrix in Immediate Prepectoral Implant-based Breast Reconstruction

Best Practices for BREAST-Q Research: A Systematic Review of Study Methodology

The Bell Pattern: A Novel Breast Incision Approach to Skin-Reducing Mastectomies

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